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December 17, 2012

ABQ Journal Editorial on Medicaid Fraud

This editorial appeared in Sunday's Albuquerque Journal.

Editorial: AG Needs To Wake Up, Bust the Medicaid Fraud

The office of New Mexico Attorney General Gary King is doing a little better at ferreting out Medicaid fraud — it recovered $3.4 million in fiscal 2011 compared to $2.4 million in fiscal 2010.
But that is still way below average, among the worst in the nation. And with 170,000 New Mexicans poised to join the Medicaid rolls under Obamacare should New Mexico opt in, King needs to get serious about restoring integrity to the system and the bottom line.

And stop giving excuses for why this performance is OK in a state with an estimated $75 million in Medicaid fraud annually.

The national average for Medicaid fraud recovery is $3,700 per $1 million in Medicaid spending; nearly $10 for every $1 spent in fighting fraud. King’s office recovered $988 for every $1 million in

Medicaid spending; $2.74 for every $1 spent in fighting fraud.

When confronted with the disparity, his office provided a letter from the National Association of (state) Medicaid Fraud Control Units to the federal director of Medicaid fraud policy and oversight. Tt says “prosecutorial activity cannot be measured by standardized measurement, review and comparison. Each unit is different and operates differently.”

King is right on one count — his Medicaid Fraud and Elder Abuse Division is very different. According to a Legislative Finance Committee report, it does less with more than those in other states, has a problematic organizational structure, too few special agents, too many open positions, a high rate of outstanding referrals and a backlog of open cases.

King has also said the recovery comparisons don’t take into account his office’s focus on investigating and prosecuting elder abuse, which doesn’t produce a recovery.

But stealing public money intended to pay for seniors’ care — as well as the care of disabled people— is abuse. It’s King’s job to uncover and punish it and protect some of the state’s most vulnerable residents.

And with a potential 170,000 new Medicaid clients in the wings, it’s time for him to start doing that job well.

This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.

Any Comments?  Share Below. 


  1. Watch out Dr. Babk Mirin - the AG is gonna getcha!

  2. I hope mirins name is at the top of the ag's list!!!

  3. DDSD is one of the biggest departments that is complicit Medicaid fraud. The current leadership is controlled by providers who perform the fraud. The current leadership refuses to address any DDSD provider misdeeds. I wonder why? Heck contractors even bill prior to performing services. Shh.... don't mention it or you will lose your job. In fact, the current leadership at DDSD is so controlled by one particular provider that she will bend over backwards to rake state employees through coals to gain favor. Again, look at contracts and contract performance in DDSD. The current leadership has been around for a while. Heck program managers sleep with the providers they have direct oversight. DDSD equals a hotbed of egos, corruption, discrimination and lies.

  4. That's very sad about DDSD. ASD does not fair any better. Duffy left us stuck with Bernice, and Mike. We also had Bernice bring in all her sleaze bag friends like Renee, Nikki, and the rest of the bag of trash. No other agency will touch none of these crappy fools. We're stuck with them until they go to jail or retire, sigh:((

    1. I am the ghost of Christmas to come. Mike and Bernice, take a look at Jim Green as he walks on down the halls of the Runnels Building. See how he walks like a little sad kid with his head hung low. He is remembering all the people he has hurt or screwed over. Some living, some dead, and some retired. He is a very sad person just like the two of you. But on the bright side, Merry Christmas!! Time catches up with all of us, just ask Jim's friend Ben.

    2. I am a fired DOH employee. For the first time in my children's lives, I have NO presents for them - zero, nilch. The tree is empty... unemployment running out. Why? Egos, lies and corruption. I am sure those who fired me are having a wonderful holiday season - not fair at all. It is a shame that the corrupt go without regard for people's families - awful!!!

    3. I doubt if the people who fired you are happy. Evil takes its toll. May the spirit of the holidays bring happiness into your and your family's hearts.

    4. I too am a fired DOH employee. Unemployment will soon run out. Am ill without funds to pay the high co-pays for doctors because I'm using cashed out PERA funds to pay high COBRA premiums. All alone during holidays because DOH has bullied everyone into isolating me. The ones responsible all have their jobs and have no worries during this holiday season. However, I am a true believer in KARMA. I did nothing to deserve what was done to me as I know is true for others. Hold tight to your families and loved ones and know "what goes around comes around." I'll continue to fight for what is right and DOH Nation, you too, must stand up to these bullies if not for yourselves but for those we are charged to care for.

  5. Actually, if the press in New Mexico REALLY did their jobs, a lot of this Medicaid fraud would have been prevented some time ago. I am glad the editorial board at ABQ Journal is enlightening the public - which is the function of the press in a democracy. I have been pleading that people call CNN. In fact, I am aware of a big issue with a particular Medicaid contractor that would blow the lid off DDSD and HSD. I will give everyone a clue - once the Santa Fe New Mexican gets the list of fired employees. Contact those people, I am pretty damn sure someone knows about illegal deals at many DOH departments. The current leadership there is corrupt. Trust me, the list of fired individuals during the Torres reign will hold the key to the treasure trove of lies, illegal contract dealings and discrimination at DOH. I also know that if the firings of these issues had ever reached the Governor's office - there was spin given to her. I will the Governor the benefit of the doubt. I wonder if she REALLY knew why some of these people were fired.... At any rate, the current DDSD leadership (except JTL and MK) are corrupt. You may not agree with JTL about policy but she is not corrupt. The ability to lie without hesitation is appalling at DDSD. Any testimony in court cases (including the Jackson and Foley lawsuits) is definitely in jeopardy because the current leadership are liars. Sorry... bold faced liars. In fact, if I worked for attorneys in the Jackson and Foley court cases, I would ALSO contact the fired individuals. I am sure a pattern of lies, corruption would taint the testimony of anyone currently in leadership (except JTL and MK). In fact, of the fired individuals... find out what happened to the hard drives of their computers.... that will definitely open the door to why they were fired.

  6. Whether or not she knew specifics, the Governor is still ultimately responsible.

  7. Yeah... you are right. She is ultimately responsible. Let's see if she will do a sweep of DOH and each firing before those individuals come together and garner the attention of national press. Especially with all the budget talk issues, I am sure the federal funds are of interest (hint, wink and everything else).

  8. DRNM, The Arc and families are up in arms regarding the new waiver. Guess what? They should be. If you think hard, several DDSD staff quit or were fired (even the Director) during the time of the SIS implementation. The public needs ask why? These individuals were very qualified, astute and had stellar reputations. So why were these individuals (including the Director) fired prior to the final phase of the contract in which rates and services were adjusted. Come on think public. Think. This is not a coincidence. These individuals had integrity were in the way of the current/new DDSD leadership and the out-of-state contractor's lucrative deal. Contact the fired individuals and the public will have intimate knowledge of how the current DDSD leadership bamboozled the public and actively sought to ruin the professional lives of astute people who would not stand for those types of dealings.

  9. BTW.... the current DDSD leadership not only bamboozled the public but also the Governor. The Governor will have to answer to the public about these out-of-state contractors with less than adequate performances as well as the concerted effort from all levels of DOH to illegally fire individuals who were in the way of these kick-backs - oops! I mean contracts - Freudian slip.

  10. I wonder how the AG investigation of Dr. Babak Mirin is going? He has been suspended as a Medicaid provider yet he keeps billing Optum. Hmmmm.

  11. A lot of DOH alumni are being affect by the mess! Johnathon can you ask people to support this campaign? Thanks

  12. Has everyone seen the story unfold at Rutgers? A whisleblower was fired and guess what? When the story came to the public was just as outraged as the whistleblower. I'm telling you the citizens of new mexico should have the back of whistleblowers in the DOH. Every last one of them is telling truth. Again, look at the staff who were fired. I am sure they expressed concerns regarding DOH's unwillingness to follow the law or a health disregard for the public. Get the numbers to these public employees ask them questions, and LOTS of questions: Anita Westbrook, Cathy Stevenson, Roberta Duran, Deb Vering, Brad McGrath..... dig and ask these people questions. Look at every firing they were involved in and public will find the truth... c'mon New Mexico you can do it!


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